Provider Demographics
NPI:1730884461
Name:ALLEN, CHANNCE SEBASTIAN
Entity type:Individual
Prefix:
First Name:CHANNCE
Middle Name:SEBASTIAN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 IRON FORGE RD
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1716
Mailing Address - Country:US
Mailing Address - Phone:202-531-9271
Mailing Address - Fax:
Practice Address - Street 1:900 G ST NE APT 204
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7404
Practice Address - Country:US
Practice Address - Phone:202-365-0484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant